Patients with spinal cord injuries are known to have a significantly increased risk (over 400 fold) for developing bladder tumors. Unfortunately, bladder cancer in these patients often presents late, at an aggressive stage, typically indicating a poor prognosis. The early diagnosis of bladder cancer is central to the effective treatment of the disease. An aggressive regular evaluation schedule with cystoscopy, cytology and bladder biopsies is necessary at the present time to detect these tumors in this high-risk population. A sensitive and non-invasive screening procedure, utilizing a bladder cancer marker, would substantially facilitate the detection of tumors in this population. Recently, various urine-based tests for bladder cancer have become available. They have demonstrated varying degrees of efficacy in identifying patients with bladder cancer in the general population. The efficacy of these markers, specifically in patients with spinal cord injury has not been studied. This is necessary when considering the differences in the disease in these individuals along with the co-existing conditions. In this project, the aim is to evaluate the efficacy of a novel marker for bladder cancer as well as of two commercially available markers in a cohort of patients with spinal cord injury. The markers to be studied are: (l) the BLCA-4 assay - a bladder cancer specific nuclear matrix protein present in elevated levels in the urine of patients with bladder cancer; (2) the BTA assay - a urine-based test to detect presence of a marker derived from the basement membrane of bladder cancer cells which is a tumor antigen reported to be a member of the complement H factor family and (3) NMP22 - a urine-based test which detects elevated levels of a generic nuclear matrix protein in patients with bladder cancer. These tests will also be compared to routine voided urine cytology which is the standard diagnostic test currently used to screen and detect bladder cancer in these patients. Cystoscopy and biopsy of visible lesions will be the definitive method of diagnosis of bladder cancer. Such a comparative analysis will allow to determine the optimal and most effective test that can be used to screen and monitor spinal cord injured patients for bladder cancer.